Inadequate diet, physical activity, and sleep-related behaviors are potential risk factors for overweight and obese, therefore we investigated the relations between body mass index (BMI) and ...behavioral factors in a sample of Italian adolescents. Four hundred nine Italian secondary school students (46% females, 12.5 ± 0.6 y.o.) were enrolled in this cross-sectional study. Anthropometric measures, adherence to the Mediterranean Diet (KIDMED), physical activity level (PAQ-C), sleep duration, daytime sleepiness (PDSS), sleep quality, and school achievement data were collected through an online questionnaire. The percentage of overweight adolescents was slightly lower (14%) compared to the regional and the national figures. Approximately 88% of the sample reported a medium/high adherence to the Mediterranean Diet and 77% a moderate/vigorous physical activity level. The average sleep duration was in line with the international sleep recommendation for adolescents and 82% had a medium/high sleep quality. No differences were found between genders except for BMI (lower in females). Unexpectedly, no differences were found among the BMI groups (normal weight vs. overweight vs. obese) for lifestyle variables; in contrast, Mediterranean Diet adherence was associated with sleep habits. Further investigation is required to better explore the associations among behavioral variables involved in adolescents' healthy development.
The prevalence of overweight and obesity in children has risen greatly worldwide. Diet and poor physical activity are the two risk factors usually examined, but epidemiological evidence exists ...suggesting a link between sleep duration and overweight/obesity in children. The aim of this study was to describe the relationship among body mass index (BMI), diet quality, physical activity level, and sleep duration in 690 children attending the 5th grade in primary schools (9-11 years old) in the city of Parma (Italy) involved in the Giocampus educational program. This was achieved through (i) measuring anthropometric data to compute body mass index; (ii) administering a food questionnaire to evaluate adherence to the Mediterranean Diet (KIDMED score); and (iii) administering a lifestyle questionnaire to classify children physical activity level (PAL), sleep duration, and school achievement. A highly significant negative association was found between BMI and sleep hours. Moreover, there was a significant positive association between PAL and KIDMED scores. No evidence was found of association between BMI and PAL, nor between BMI and KIDMED score. Data from this study established that BMI is correlated to gender and sleep duration, defining sleep habits as one of the factors linked to overweight and obesity.
Abstract Objective The relationship between CAP parameters and subjective time perception during sleep in primary insomnia was investigated. Patients and methods Data collected from all-night PSG ...recordings of 20 patients with a diagnosis of paradoxical insomnia (misperceptors) were compared with those of 20 normal gender- and age-matched subjects (controls). Besides sleep staging, scoring measures included CAP parameters and EEG arousals. Results Patients and controls presented non-significant differences in the amounts of objective sleep time (464 min vs. 447 min) and objective sleep latency (9 min vs. 8 min). Compared to controls, misperceptors reported a significantly shorter time of perceived sleep (285 min vs. 461 min) and a significantly longer duration of perceived sleep latency (51 min vs. 22 min). In spite of the 11 objective awakenings, misperceptors reported only 4 subjective awakenings, while controls described 2 of the 5 objective awakenings. Arousal index (31.7/h vs. 18.6/h) and total CAP rate (58.1% vs. 35.5%) were significantly higher in misperceptors. In the sleep period between objective and subjective sleep onset, CAP rate was 64.4% in misperceptors and 45.1% in controls ( p < 0.002). Insomniacs showed significantly higher amounts of CAP rate in stage 1 (62.7% vs. 37.5%) and in stage 2 (53.3% vs. 33.1%), but not in slow wave sleep. CAP phase A2 subtypes were significantly increased in misperceptors (31% vs. 24%). Conclusions The study points out the topical role of enhanced activation and arousal instability not only in the first part of the night (mismatch between objective and subjective sleep onset) but also in the misperception of consecutive objective awakenings which are subjectively grouped together as a single prolonged event.
The scoring of American Academy of Sleep Medicine (AASM) arousal is mandatory for the definition of respiratory event-related arousal (RERA). However there are other EEG activation phenomena, such as ...A phases of cyclic alternating pattern (CAP) which are associated with respiratory events in non rapid eye movements (NREM) sleep. This study aims at quantifying the additional value of CAP for the definition of respiratory events and sleep alterations in OSAS.
Analysis of polysomnographic recordings from nineteen OSAS patients was carried out. Scoring was focused on investigation of the cerebral response to flow limitation (FL) events. For this purpose we used both CAP rules and AASM arousal criteria.
While no difference was demonstrated in the arousal index between mild and moderate-severe OSAS patients, CAP time showed a progressive enhancement from normal subjects (152.5±20.76) to mild (180.64±34.76) and moderate-severe (282.27±58.02) OSAS patients. In NREM sleep, only 41.1% of FL events met the criteria for the definition of RERA, while, 75.5% of FL events ended with a CAP A phase and most FL CAP (69.1%) terminated with a CAP phase A3 subtype.
Our data indicate that the RERA scoring has a limited accuracy in the detection of FL events. In NREM sleep, CAP rules provided more information than AASM arousal for the definition of respiratory events and sleep alterations in OSAS.
The relevance of sleep instability is poorly appreciated among the metrics of sleep physiology. The cyclic alternating pattern (CAP) is a periodic electroencephalogram activity of non-REM sleep, ...characterized by sequences of transient electrocortical events that are distinct from the tonic background and recur at up to 1-min intervals. In the dynamic organization of sleep, CAP expresses a condition of instability that reflects the brain's effort in preserving and regulating the physiological structure of sleep.
CAP quantification is a topical feature in the evaluation of sleep quality. In addition to duration, depth, and continuity, sleep restorative properties depend on the brain's capacity to determine the periods of sustained stable sleep. This issue is not confined only to the electroencephalogram activities but reverberates upon the ongoing autonomic and behavioral functions, which are mutually entrained in a synchronized oscillation. As a master clock involved in the dynamic organization of sleep, CAP plays a crucial role in numerous sleep disorders and is powerfully influenced by medication and appropriate treatment.
This article reviews the scoring, significance, and clinical applications of CAP.
Objective: Electroencephalography (EEG) is widely employed in the study of sleep disorders. This paper exploits the identification of cyclic alternating patterns (CAPs), a periodic ubiquitous ...phenomenon nested in the sleep stages, to analyze the EEG spectral coherence in subjects affected by nocturnal frontal lobe epilepsy (NFLE) and healthy controls. Methods: For each EEG recording, we extracted several CAP A1 subtype 4 s time series. We analyze the coherence between each pair of electrodes for each individual to obtain its distribution for each frequency range of interest to investigate differences between cases and controls. In addition, the imaginary and real parts of the spectral coherence were calculated and plotted to assess their likelihood of segregation into different classes and anatomical regions. Results: The results of this study suggest a relevant frontal-temporal neural circuitry difference between individuals affected by epilepsy and controls. Conclusion: This supports the observation that, though highly variable, a broad range of executive, cognitive and attentional deficit observed in subjects affected by NFLE might depend on frontal-temporal altered networking. Significance: The investigation of EEG activity in the domain of the complex sleep architecture represents a challenging topic in neurophysiology and needs new methods to explore the manifold aspects of sleep. This work aims to provide a simple method to distinguish NFLE from healthy subjects from a functional connectivity point of view and to explore the possibility of using a smaller EEG channel set to support diagnosis.
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease due to loss of motor neurons. However, the autonomic nervous system (ANS) can also be involved. The aim of this research ...was to assess the sleep macro- and microstructure, the cardiac ANS during sleep, and the relationships between sleep, autonomic features, and clinical parameters in a cohort of ALS patients.
Forty-two consecutive ALS patients underwent clinical evaluation and full-night video-polysomnography. Only 31 patients met inclusion criteria (absence of comorbidities, intake of cardioactive drugs, or recording artifacts) and were selected for assessment of sleep parameters, including cyclic alternating pattern (CAP) and heart rate variability (HRV). Subjective sleep quality and daytime vigilance were also assessed using specific questionnaires.
Although sleep was subjectively perceived as satisfactory, compared with age- and sex-matched healthy controls, ALS patients showed significant sleep alteration: decreased total sleep time and sleep efficiency, increased nocturnal awakenings, inverted stage 1 (N1)/stage 3 (N3) ratio, reduced REM sleep, and decreased CAP rate, the latter supported by lower amounts of A phases with an inverted A1/A3 ratio. Moreover, a significant reduction in HRV parameters was observed during all sleep stages, indicative of impaired autonomic oscillations.
Our results indicate that sleep is significantly disrupted in ALS patients despite its subjective perception. Moreover, electroencephalogram activity and autonomic functions are less reactive, as shown by a decreased CAP rate and a reduction in HRV features, reflecting an unbalanced autonomic modulation.
Summary
The study aims at assessing the changes in electroencephalography (as measured by the A‐phases of cyclic alternating pattern) and autonomic activity (based on pulse wave amplitude) at the ...recovery of airway patency in patients with obstructive sleep apnea syndrome. Analysis of polysomnographic recordings from 20 male individuals with obstructive sleep apnea syndrome was carried out in total sleep time, non‐rapid eye movement and rapid eye movement sleep. Scoring quantified the combined occurrence (time range of 4 s before and 4 s after respiratory recovery) or separate occurrence of A‐phases (cortical activation), and pulse wave amplitude drops (below 30%) to apneas, hypopneas or flow limitation events. A dual response (A‐phase associated with a pulse wave amplitude drop) was the most frequent response (71.8% in total sleep time) for all types of respiratory events, with a progressive reduction from apneas to hypopneas and flow limitation events. The highly significant correlation in total sleep time (r = 0.9351; P < 0.0001) between respiratory events combined with A‐phases and respiratory events combined with pulse wave amplitude drops was confirmed both in non‐rapid eye movement (r = 0.9622; P < 0.0001) and rapid eye movement sleep (r = 0.7162; P < 0.0006). In conclusion, a dual cortical and autonomic activation is the most common manifestation at the recovery of airway patency. The significant correlation between A‐phases and relevant pulse wave amplitude drops suggests a possible role of pulse wave amplitude as a marker of cerebral response to respiratory events.
Summary
Objective
Nocturnal frontal lobe epilepsy (NFLE) is an idiopathic partial epilepsy with a family history in about 25% of cases, with autosomal dominant inheritance (autosomal dominant NFLE ...ADNFLE). Traditional antiepileptic drugs are effective in about 55% of patients, whereas the rest remains refractory. One of the key pathogenetic mechanisms is a gain of function of neuronal nicotinic acetylcholine receptors (nAChRs) containing the mutated α4 or β2 subunits. Fenofibrate, a common lipid‐regulating drug, is an agonist at peroxisome proliferator‐activated receptor alpha (PPARα) that is a ligand‐activated transcription factor, which negatively modulates the function of β2‐containing nAChR. To test clinical efficacy of adjunctive therapy with fenofibrate in pharmacoresistant ADNFLE\NFLE patients, we first demonstrated the effectiveness of fenofibrate in a mutated mouse model displaying both disease genotype and phenotype.
Methods
We first tested the efficacy of fenofibrate in transgenic mice carrying the mutation in the α4‐nAChR subunit (Chrna4S252F) homologous to that found in humans. Subsequently, an add‐on protocol was implemented in a clinical setting and fenofibrate was administered to pharmacoresistant NFLE patients.
Results
Here, we show that a chronic fenofibrate diet markedly reduced the frequency of large inhibitory postsynaptic currents (IPSCs) recorded from cortical pyramidal neurons in Chrna4S252F mice, and prevented nicotine‐induced increase of IPSC frequency. Moreover, fenofibrate abolished differences between genotypes in the frequency of sleep‐related movements observed under basal conditions. Patients affected by NFLE, nonresponders to traditional therapy, by means of adjunctive therapy with fenofibrate displayed a reduction of seizure frequency. Furthermore, digital video‐polysomnographic recordings acquired in NFLE subjects after 6 months of adjunctive fenofibrate substantiated the significant effects on control of motor–behavioral seizures.
Significance
Our preclinical and clinical studies suggest PPARα as a novel disease‐modifying target for antiepileptic drugs due to its ability to regulate dysfunctional nAChRs.
the study aims at describing the role of sleep disordered breathing (SDB) on daytime symptoms, quality of sleep and quality of life (QoL) in patients with moderate-severe IPF.
we enrolled 34 ...consecutive room air breathing IPF outpatients who received a full-night polysomnography. The following questionnaires were administered: Epworth Sleepiness Score (ESS), Pittsburg Sleep Quality Index (PSQI), StGeorge's Questionnaire (StGQ).
patients were classified in 3 groups:Group A (NO-SDB, 9 patients), Group B(OSAS without sleep–related hypoxemia, 17 patients), Group C(OSAS with sleep–related hypoxemia, 8 patients). Although sleep parameters showed no significant differences among the 3 groups, worse measures were found in group C. 50% of patients (17/34) reported a StGQ score indicating a reduced QoL and the StGQ score was significantly higher in group C patients compared to group A (p < 0.05). In the stepwise multiple regression analysis, 75% of StGQ score variability was significantly predicted by FVC(Forced Vital Capacity) %, DLco (diffusion lung capacity for carbon monoxide)%, PSQI and ESS.
in patients with IPF both subjective and polysomnographic poor sleep quality are extremely common features, they are predicted by variables associated with SBD severity and are linked to low QoL. IPF with more severe SDB present poor sleep quality and a worse QoL compared to SDB-free or OSAS-only.
•Poor sleep quality is associated with poor QoL in IPF patients.•Poor sleep quality is predicted by variables associated with SDB.•IPF patients with more severe SDB have worse QoL compared to SDB-free or OSAS-only.
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